States Can Test Medicaid Work Requirements

January 11, 2018

CMS issues guidance allowing states to propose programs

The Trump administration will allow states to test requiring some Medicaid recipients to work or participate in community activities such as volunteering or jobs training as a condition of eligibility for the government health insurance program for the poor.

The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements, according to a Reuters report. States must propose such changes through waivers and receive federal approval.

Seema Verma, the agency’s administrator, said the policy guidance came in response to requests from at least 10 states that have proposed requiring some Medicaid recipients to work or participate in activities that may include skills training, education, job search, volunteering, or caregiving. Those states include Kentucky, Maine, New Hampshire, Arizona, Indiana, and Utah.

Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children, and pregnant women. Verma also said states would have to make “reasonable modifications” for those battling opioid addiction and other substance use disorders.

“This gives us a pathway to start approving waivers,” Verma said. “This is about helping those individuals rise out of poverty.”

Under the 2010 Patient Protection and Affordable Care Act, former President Barack Obama’s signature domestic policy achievement, 31 states expanded Medicaid to those making up to 138% of the federal poverty level, adding millions of people to the rolls. Republicans have repeatedly failed to repeal and replace the act, a top campaign promise of President Donald Trump. Instead, the Trump administration has sought to weaken the program through executive orders and administrative rules.

The Obama administration opposed state efforts to implement work requirements in Medicaid because it could result in fewer people having access to health insurance.

For instance, Kentucky last year proposed work requirements for able-bodied adults to get insurance and establishing new fees for all members based on income. A study found the proposal would reduce the number of residents on Medicaid by nearly 86,000 within five years, saving more than $330 million.

Republicans argue that Medicaid was created to serve the most vulnerable and has become bloated under Obamacare. Verma and other Republicans said implementing work and community engagement requirements could help improve health outcomes by connecting people with jobs and training, Reuters reported.